Pacific Therapy Group, PLLC

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

Legal business name

PACIFIC THERAPY GROUP, PLLC

Practice address

1601 116TH Ave NE
Suite 114
Bellevue, WA 98004-3010

Phone

(425) 454-7541

Fax

(425) 454-1142

NPI assigned

Sep 28, 2009

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Mary Anderson, PSYD

Title

Owner/Member

Phone

(425) 454-7541

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in WA

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Mary A Risdon, PSYD

  • Clinical Psychologist
  • Bellevue, WA
  • NPI 1891857520
  Medicare reassignment NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1254096000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1337558400000",
    "number": "1053645754",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1601 116TH AVE NE",
            "address_2": "SUITE 114",
            "city": "BELLEVUE",
            "state": "WA",
            "postal_code": "980043010",
            "telephone_number": "425-454-7541",
            "fax_number": "425-454-1142"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1601 116TH AVE NE",
            "address_2": "SUITE 114",
            "city": "BELLEVUE",
            "state": "WA",
            "postal_code": "980043010",
            "telephone_number": "425-454-7541",
            "fax_number": "425-454-1142"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PACIFIC THERAPY GROUP, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-09-28",
        "last_updated": "2012-05-21",
        "status": "A",
        "authorized_official_last_name": "ANDERSON",
        "authorized_official_first_name": "MARY",
        "authorized_official_title_or_position": "OWNER/MEMBER",
        "authorized_official_telephone_number": "425-454-7541",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PSYD"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "WA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Wendy Pacifici, LCSW
• Albert Dominick Pacifico II, M.D.
• Scott Alexander Packebush

• Community/Behavioral Health Agency in Bellevue, WA
• Providers in Bellevue, WA by specialty
• Community/Behavioral Health Agency in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 21, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.